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STUDIA UNIVERSITATIS MOLDAVIAE, 2018, nr.9(119)
Seria “{tiin\e ale educa\iei” ISSN 1857-2103 ISSN online 2345-1025 p.94-98
CZU: 343.54:159.9
STRUCTURAL-STRATEGIC APPROACHES TO COUPLE AND FAMILY THERAPY
STRUGULING WITH ABUSE AND DOMESTIC VIOLENCE
*
Sergiu TOMA, Victoria CAPTARI, Natalia TOMA
Institutul pentru Familie și Inițiative Sociale
*Universitatea de Stat din Moldova
The issue and the key concepts and strategies that can be successfully used when providing couple therapy as part of
the systemic therapy interventions using the basic concepts of strategic and structural family therapy are treated in the
article. The two models, structural family therapy (as developed by Salvador Minuchin) and strategic family therapy (as
developed by Jay Haley), are presented together because of their common emphasis on systems and structure. Both
approaches aim to realign family organization to produce change in the entire system, and both are focused on the
hierarchical organization of the family. The key perspective of this article is to present the Cloe Madanes approach and
preconditions, and possible directions of interventions with families that experience domestic violence.
Keywords: structural family therapy, strategic therapy, family violence, couple therapy, psychotherapy, coalitions,
maladaptive transactions, accommodation, systemic psychotherapy, interpretation, boundaries, differentiation.
ABORDĂRI ALE PSIHOTERAPIEI DE CUPLU ȘI FAMILIE ÎN SITUAȚIE
DE VIOLENȚĂ DIN PERSPECTIVĂ STRUCTURALISTĂ ȘI STRATEGICĂ
În articol este abordată problema, conceptele-cheie și strategiile care pot fi utilizate cu succes în realizarea terapiei
de cuplu ca parte componentă a intervențiilor terapiei sistemice utilizând conceptele de bază ale terapiei strategice și
structurale.
Cele două modele – terapia structurală de familie (dezvoltată de Salvador Minuchin) și terapia strategică de familie
(dezvoltată de Jay Haley) – sunt prezentate împreună datorită faptului că ambele acordă atenție sistemelor și structurii.
Ambele abordări tind să realinieze organizarea familiei pentru producerea schimbării în întregul sistem și ambele
sunt focusate pe organizarea ierarhică a familiei.
Perspectivele centrale ale acestui demers ştiinţific constau în prezentarea abordării dezvoltate de Cloe Madanes,
precum și a precondițiilor și posibilelor direcții de intervenții în familiile care cunosc violența domestică.
Cuvinte-cheie: terapie structurală de familie, terapie strategică de familie, violență domestică, terapie de cuplu,
psihoterapie, coaliții, tranzacții dezadaptative, acomodare, psihoterpie sistemică, interpretare, limite, diferențiere.
Theoretical aspect of the two models
Both structural and strategic approaches stem from communication theory as advanced by Bateson and
colleagues-most notably, Don Jackson, John Weakland, and Gregory Bateson, in Palo Alto [1]. The structural
and strategic approaches share many fundamental principles. The first is that human behaviour, including
psychopathology, must be understood within the context in which it occurs. Human contexts are systems
with rules that regulate behaviour and reciprocal processes, such as the behaviour of one part of the system
influences the behaviour of other parts. The most influential human context is the family system. The family
is a self-correcting, homeostatic system, in which deviance from the normative pattern of interaction activates a
governing process. If a person deviates from the repeating behaviour and so defines a different interaction,
the others react against that deviation and shape the behaviour back into the habitual pattern. One of the
goals of the structural approach is to help individuals to experience themselves, including their problems, as
belonging to part of a larger whole. When the individual is seen as part of a larger entity, his or her behaviour
can be understood as complementary or reciprocal to another behaviour.
The structural and strategic approaches view problems as stemming from rigid and repetitive patterns of
interaction that restrict the repertoire of available behaviours. Both see pathology as a failure of the family to
adapt to changed circumstances as the family proceeds through developmental stages and when outside
forces pushe away to require adjustment. In pathological families, instead of adjusting by expanding their
range of behaviours, the family more rigidly adheres to its habitual patterns. New functions must appear as
the family goes through developmental stages, that is, couple formation, young children, school age and
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STUDIA UNIVERSITATIS MOLDAVIAE, 2018, nr.9(119)
Seria “{tiin\e ale educa\iei” ISSN 1857-2103 ISSN online 2345-1025 p.94-98
adolescent children, grown children, and non-normative transitional incidents (such as illness, loss of a job).
Minuchin and Fishman have outlined several stages and the corresponding tasks that must be accomplished [2].
An excellent resource for further understanding of family developmental stages is Carter and McGoldrick’s
The Changing Family Life Cycle (1989).
In the strategic approach, symptoms are viewed as having a function within the family. It is assumed that
a symptom metaphorically expresses a problem. Symptomatic behaviour is in some way an adaptive, albeit
unsatisfactory solution, in that a person must behave in abnormal ways when responding to abnormal social
structures. Problems in the family’s hierarchical organization are at the root of symptomatic behaviour.
Typically, the hierarchical arrangement is confused. It may be confused by being ambiguous or because a
member at one level consistently forms a coalition against a peer with a member at another level, thus
violating the basic rules of organization. This type of coalition is particularly troublesome when it is secret.
The View of Marital Problems within The two Models
In the strategic conceptualization of behaviour as determined by units of at least three persons, a marriage
does not exist as an independent entity. Marital problems can be presented in therapy through (1) a symptom
of an individual member of the couple, (2) a child problem, or (3) a direct request for marital counselling.
The symptomatic person is in an inferior position to the other spouse, who tries to help, yet the symptom-
matic spouse is also in a superior position, in that she or he refuses to be helped. The couple becomes restric-
ted to a situation where one behaviour defines both an inferior and a superior position of each spouse in
relation to the other. The symptom is a solution to the couple’s difficulties, in that it equalizes the power of
the spouses, providing a focus of interaction that stabilizes the marriage. The job of the therapist is to organize
the couple so that power and weakness are not centred on symptomatic behaviour.
For structural and strategic therapists, family interactions are the primary focus of treatment. The key to
effective intervention thus begins with an accurate assessment and clinical formulation of family interactions
that are related to the presenting problem. Assessment and clinical formulation always consider the general
nature of family functioning, as well as the specific relationship between the problem presentation and
general family functioning.
The core of assessment and diagnosis in the structural approach involves identifying repetitive interactional
patterns within the family. Diagnosis of the family system is based on observing interactions that occur in the
session. It is important to do this early in the therapy before the therapist is inducted into the family culture
and thereafter fails to see structures because he or she has become a part of them [2]. The most important
aspect of clinical assessment in the strategic approach is to have a clear and operationalized treatment goal
related to the family’s presenting symptom and the sequences of interaction that are related to the symptom.
Both structural and strategic family therapies are directive, present, and action-oriented. They stress the
importance of joining the family before changes in family structures can occur. Both rely on enactment of
interactions within the therapy session for the purposes of diagnosing and transforming interactions, assign
homework tasks, and prescribe “unbalancing” the system as a lever for changing family relationships.
Structural and strategic approaches share the tenet that symptom change and enhanced family functioning
are inextricably linked. Because symptoms are caused by rigidly repeating patterns of interaction, it follows
that the curative factor of therapy is to expand the family’s range of available responses and its ability to use
these responses to resolve its problems. Moreover, both approaches share an emphasis on the creation of an
effective hierarchical structure that helps parents function as a cohesive executive subsystem. Although both
approaches hold that changing a pattern of interaction (or a sequence of behaviour) causes family members
to undergo change, there is an important difference regarding the position of the presenting problem in this
equation. That is, the structural school views symptom resolution as a product of structural change, whereas
the strategic school focuses on symptom resolution to bring about structural change.
On Family Therapy Research about Effectiveness and Abuse
Despite the prevalence of Post-Traumatic Stress Disorder (PTSD) due to child sexual abuse, few studies
examine the clinical treatment of such children. The studies that exist are behavioural in nature and have
been conducted on children who have witnessed violence, not those who have the disorder due to sexual
abuse (Saigh, 1992).
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STUDIA UNIVERSITATIS MOLDAVIAE, 2018, nr.9(119)
Seria “{tiin\e ale educa\iei” ISSN 1857-2103 ISSN online 2345-1025 p.94-98
Using family therapy over more traditional behavioural treatments is beneficial and allows for the treat-
ment of emotional issues not addressed in behaviour therapy for PTSD. Despite rich outcome research
findings, process research into the change mechanisms of structural and strategic family therapy is limited.
The lack of research in this area is surprising because early writings included rich descriptions of process
research methods, coding procedures, and clinically relevant results whereas the establishment of the Journal
of Strategic and Systemic Therapy in 1981 provided an excellent platform for disseminating research on
structural and strategic clinical practices, systematic research failed to proliferate with the same intensity as
structural and strategic theory and clinical practice [3]. Perhaps the only exception is the rich base of research
and case studies investigating the impact of paradoxical directives and reframing techniques (cf. Weeks,
1985, 1991; Weeks & L’Abate, 1982). Further on, we review research process in the following areas: (1)
therapeutic relationship, (2) dropout, (3) linking process to outcome, and (4) paradoxical interventions.
Though the large part of structural/strategic outcome research developed over the last 2 decades has
addressed a huge umbrella of family compositions, only very few outcome studies have focused specifically
on marital and couples’ therapy. Of the few in existence, Goldman and Greenberg demonstrated that a
combined structural and strategic approach was as effective in helping couples improve their functioning as
was an emotionally focused experiential approach (emotionally focused therapy).
The model of Cloe Madanes about Principles and Strategies to Assist Families with
Abuse and Domestic Violence
The approach to treating families with abuse must be an approach that includes an interactional or systemic
viewpoint, a belief in the importance of protecting human rights, the use of directives, the necessity of using
the family as a self help group and the belief that the quickest way to change a person is to change the context
of the person. These principles are manifest in her approach to therapy [4]:
Cloe Madanes formulates five core – principles that must guide a therapist when providing family therapy
that is struggling with abuse:
1. People change when their social environment changes, so the agent (therapist or mediator) intervenes
by modifying the meaning of certain relationships (by offering a re-framing).
2. The agent is directive, and has to know what indications to give the affected family group.
3. The most important objective is the protection of the human rights of those affected. If the agent does
not protect them, it is quite possible that no other social entities that can protect them.
4. A group of people must organize to do what is morally and ethically correct. In problems of violence
and abuse, this principle is fundamental. Therapists can’t avoid treating both sides of the dyad: abused and
abusers, because therapists have to know what is right, what is wrong, and be able to draw the line so that the
family group can understand what to do.
5. In abuse cases, the pain is not only moral, but spiritual too. Since the humiliation hurts a person’s
spiritual and moral sense, to do the right thing means to restore the spirit of the people inside the right rela-
tionship. This spiritual sense is located in feelings rooted in the family network: the belief that in a family,
people who love us don’t attack us, and that we will protect each other in cases of need. A man who beats his
wife violates this family law of mutual support and care, by abusing the wife’s powerlessness.
Prior to beginning treatment, the therapist makes a risk assessment of the situation and the violence. This
includes any history of violence in each spouse’s family, an exploration of what abuse has already occurred
and an assessment for risk to the children. At the first session, or before, the therapist will request the phone
numbers of mother, father, other relatives and possibly other important “elders” in the family such as clergy,
for both spouses. If the therapist asses that there may be a risk of future violence, the following steps are
taken [5]:
Separation. The therapist will intervene immediately to separate the husband and wife before waiting for
a court order or the police. If the violence is in the past and has not been reported, the police may not become
involved until a future act of violence occurs. The therapist’s goal is to prevent this. She will tell the couple
that they must agree to a temporary, immediate, separation.
Family of origin. The therapist will then connect husband and wife to their family of origin, explaining
that they must re-establish a connection with them. If that is not possible, some other parental figure, church,
or community members will be enlisted.
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STUDIA UNIVERSITATIS MOLDAVIAE, 2018, nr.9(119)
Seria “{tiin\e ale educa\iei” ISSN 1857-2103 ISSN online 2345-1025 p.94-98
The telling. All of the family members and siblings, with as many older adults as possible, are asked to
come together for a family session. When inviting the family, the therapist requests the family to come to the
session to help the therapist. In this session, the therapist will go around the circle asking each one of the
family, including the husband, to recount all that they know about violence.
Morality. The therapist asks each person, starting with the elders, including the husband, why what the
husband did was wrong. Many times the husband will make excuses, saying that she provoked him, that he
was drunk or tired. The therapist asks the other family members to explain to him that he alone is responsible
for his acts of violence, and why it is wrong. The therapist explains that this pain of being hurt by the father
of one’s children, the person one is closest to, goes to one’s core. She states that it is not only a physical and
emotional pain but a spiritual pain, a pain to the soul. If violence occurred in previous generations the elders
will understand the pain that she is referring to. It is a spiritual pain not only in the victim and in the family
but for the offender as well and until he understands the pain and humiliation that he has inflicted on his
spouse they can not mend.
Repentance. The therapist then asks the husband to get on his knees on the floor to apologize, to express
repentance for hurting his wife and to promise never to do it again. He may apologize to his children as well.
He should not say forgive me. This step is about repentance. Therapy cannot proceed until this step is accom-
plished. This may take more than one session.
Reparation. The abuser must accomplish an act of reparation for his wife. This act should involve some
sacrifice for him, show how sorry he is and show that he loves her.
Protectors. The therapist asks the family to choose a protector for the wife who can stay very closely
involved with her. The victim may move in temporarily with this protector or the protector with her. This is
still very important if husband and wife do get back together. For example, it may be her brothers who drop
in regularly unannounced.
Consequences of future abuse. The family decides what the consequences will be if there is a re-occur-
rence of violence. The therapist encourages consequences such as pressing charges, enforced separation, and
letting his employer know what he has done.
Mentor for the violent spouse. The therapist will help the family and husband to identify someone who
can function as a mentor for him. (Steps 10, 11, and 12 take place after the therapist and the family agree that
the couple can spend together alone.)
Executive Meeting. During the week, if one partner is upset about something that the other has done,
they will not talk about it then. Instead they will write it down. Once a week, as in a corporation, the couple
will go to a public place with notes of what has to be discussed and take a meeting.
Rituals. The therapist or clients invent a ritual for setting aside the past. Madanes (personal communica-
tion, 2003) believes that the drama of the therapy must match the drama of the problems they present. The
ritual may also be as mundane as renewing their wedding vows in the therapist’s office.
Creating good memories. Couples may forget, in the tedium and difficulty of everyday life, what drew
them together, what it felt like when they were first in love. The therapist asks the couple to do something
very special that they will remember happily twenty years from now. To get rid of violence, it is not necessary
to always focus on violence.
Conclusions
Strategic and structural interventions within a family context are complex, scientifically proven appro-
aches that during the last 50 years have shown their clinical use within different professional circumstances.
Focusing on the ideas of symptom, power, transition and boundaries the approaches give a holistic view of
the individual and the psychopathology and their treatment. At the same time there is no relevant research
that can provide a unique model that can be best and in the most effective way deal with family abuse and
violence due to cultural, legal, social and psychological aspects involved. At the same time the core and
fundamental principle must be the safety of the victim. It is well documented in the literature that most
abusers are not abusive with everyone. They may control themselves well when the motivation to do so is
strong, for example, at their work. This may be why anger management is not useful. The issue is not that he
cannot control his impulses; it is that he chooses not to because of the satisfaction or release he gets from
indulging them. These interventions deal with the abuser’s choice to abuse.
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